Provider Demographics
NPI:1851695936
Name:WALGREENS SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:WALGREENS SPECIALTY PHARMACY LLC
Other - Org Name:WALGREENS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-527-4640
Mailing Address - Street 1:104 WILMOT RD
Mailing Address - Street 2:MSC 1435
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5121
Mailing Address - Country:US
Mailing Address - Phone:217-709-2386
Mailing Address - Fax:
Practice Address - Street 1:104 WILMOT RD
Practice Address - Street 2:MSC 1435
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5121
Practice Address - Country:US
Practice Address - Phone:217-709-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS BOOTS ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-04
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy